Provider Demographics
NPI:1932289766
Name:JUAN A SERRANO
Entity Type:Organization
Organization Name:JUAN A SERRANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-740-0860
Mailing Address - Street 1:AL20 CALLE 30
Mailing Address - Street 2:SANTA JUANITA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4706
Mailing Address - Country:US
Mailing Address - Phone:787-740-0860
Mailing Address - Fax:787-740-0860
Practice Address - Street 1:AL20 CALLE 30
Practice Address - Street 2:SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4706
Practice Address - Country:US
Practice Address - Phone:787-740-0860
Practice Address - Fax:787-740-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR300291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38215Medicare ID - Type UnspecifiedPROVIDER NUMBER